Activities of daily living as an additional predictor of complications and outcomes in elderly patients with acute myocardial infarction
Authors Nakajima H, Yoshioka J, Totsuka N, Miyazawa I, Usui T, Urasawa N, Kobayashi T, Mochidome T
Received 25 February 2016
Accepted for publication 24 May 2016
Published 24 August 2016 Volume 2016:11 Pages 1141—1147
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 3
Editor who approved publication: Dr Richard Walker
Hiroyuki Nakajima,1 Jiro Yoshioka,2 Nobuyuki Totsuka,2 Izumi Miyazawa,2 Tatsuya Usui,2 Nobuyuki Urasawa,2 Takahiro Kobayashi,3 Tomoaki Mochidome4
1Department of Cardiology, Nagano Matsushiro General Hospital, 2Department of Cardiology, Nagano Red Cross Hospital, 3Department of Cardiology, Nagano Municipal Hospital, Nagano, 4Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
Background: Age is an important determinant of outcome in acute myocardial infarction (AMI). However, in clinical settings, there is an occasional mismatch between chronological age and physical age. We evaluated whether activities of daily living (ADL), which reflect physical age, also predict complications and prognosis in elderly patients with AMI.
Design: Single-center, observational, and retrospective cohort study.
Methods: Preserved ADL and low ADL were defined according to the scale for independence degree of daily living for the disabled elderly by the Japanese Ministry of Health, Labour, and Welfare. We examined 82 consecutive patients aged ≥75 years with AMI who underwent primary percutaneous coronary intervention. Patients were divided into preserved ADL (n=52; mean age, 81.8±4.8 years; male, 59.6%) and low ADL (n=30; mean age, 85.8±4.7 years; male, 40.0%) groups according to prehospital ADL.
Results: The prevalence of Killip class II–IV and in-hospital mortality rate were significantly higher with low ADL compared to that with preserved ADL (23.1% vs 60.0%, P=0.0019; 5.8% vs 30.0%, P=0.0068, respectively). Multivariate analysis showed that ADL was an independent predictor of Killip class II–IV and 1-year mortality after adjusting for age, sex, and other possible confounders (odds ratio 5.11, 95% confidence interval [CI] 1.52–17.2, P=0.0083; hazard ratio 4.32, 95% CI 1.31–14.3, P=0.017, respectively).
Conclusion: Prehospital ADL is a significant predictor of heart failure complications and prognosis in elderly patients with AMI undergoing primary percutaneous coronary intervention, irrespective of age and sex.
Keywords: acute myocardial infarction, activities of daily living, disability, Killip classification, primary percutaneous coronary
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